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Recognizing the Co-occurring Signs of PTSD and Substance Use Disorder (SUD) and What to Do

In the realm of addiction recovery and transformational life coaching, recognizing the co-occurring signs of PTSD (Post-Traumatic Stress Disorder) and SUD (Substance Use Disorder) is essential. These two conditions often intertwine, creating a complex web of challenges that require a nuanced approach to treatment and support.

I was diagnosed with PTSD about 20 years ago after suffering childhood abuses, later sexual abuse including rape and lastly therapy abuse. It was the therapist's abuse that caused my mid-life PTSD. Having PTSD from childhood compounded by that PTSD led me to despair, deep emotional pain and finally the bottle to escape.

I thought alcohol would help - it was the solution to my problem. But, it ultimately led to alcoholism. From researching this topic, I've found PTSD is often connected with alcoholism and addiction. As usual, I wasn't alone or unique.

Understanding PTSD and SUD

PTSD is a mental health condition triggered by experiencing or witnessing a traumatic event, characterized by symptoms such as flashbacks, severe anxiety, and uncontrollable thoughts about the trauma. SUD involves the overuse of substances like alcohol or drugs, leading to significant impairment and distress. When these conditions co-occur, they can exacerbate each other, making recovery more challenging but not impossible.

Recognizing the Signs

Identifying the signs of co-occurring PTSD and SUD is the first step toward effective intervention. Here are key indicators to look for:

  1. Avoidance Behavior: Individuals with PTSD often avoid places, people, or activities that remind them of their trauma. This avoidance can extend to daily activities, leading to social isolation. When SUD is present, avoidance may also involve using substances to escape these reminders. When I was suffering from PTSD and alcoholism I developed a fear of leaving the house and cut off all outside interests. My world shrank to a bottle and living room sofa.

  2. Hyperarousal Symptoms: This includes heightened anxiety, irritability, difficulty sleeping, and an exaggerated startle response. Those with co-occurring SUD might use substances to calm these heightened states, creating a cycle of dependency. I was constantly jumpy and nervous. I also couldn't stand noise or bright lights. Sleep? When I could - which wasn't often - I had horrible nightmares, night terrors, screaming, falling out of bed, sleep paralysis. I dreaded going to bed!

  3. Intrusive Thoughts and Flashbacks: Persistent, distressing memories or flashbacks of the traumatic event are common in PTSD. Individuals may use substances to dull these intrusive thoughts, leading to increased substance use and dependency. My mind was constantly in the past with dark thoughts of what I'd gone through. I didn't know how to stop them, so I drank to numb myself and black out.

  4. Increased Substance Use: A noticeable increase in the use of alcohol or drugs to manage emotional pain and stress is a red flag. This coping mechanism, while offering temporary relief, often leads to a deepening of both PTSD and SUD symptoms. I started with boxes of wine and finally switched to vodka because it was cheap, more potent and easier to hide. At the end of my drinking I was 24/7 and about a half GALLON of cheap vodka a day!

  5. Emotional Numbness: Feeling detached from others, lack of interest in activities once enjoyed, and a sense of hopelessness are common in PTSD. Substances might be used to artificially induce feelings of pleasure or to continue numbing the emotional pain. I was in so much turmoil and deep emotional pain, I would drink till I passed out then wake up and do it again. What a living nightmare.

What to Do

Addressing co-occurring PTSD and SUD requires a comprehensive and integrated approach. Here are some strategies to consider:

  1. Seek Dual Diagnosis Treatment: Dual diagnosis treatment centers specialize in treating both PTSD and SUD simultaneously. This integrated approach ensures that both conditions are addressed concurrently, increasing the chances of successful recovery.

  2. Engage in Therapy: Cognitive-behavioral therapy (CBT) and other trauma-focused therapies can help individuals understand and reframe the thoughts and behaviors contributing to their PTSD and SUD. Therapy can provide tools to manage triggers and develop healthier coping mechanisms.

  3. Join Support Groups: Support groups, such as Alcoholics Anonymous (AA), 12 Step programs, and trauma-focused groups, offer a community of individuals who understand the challenges of living with PTSD and SUD. Sharing experiences and receiving support from peers can be incredibly therapeutic.

  4. Practice Mindfulness and Relaxation Techniques: Incorporating mindfulness practices, such as meditation, yoga, and deep breathing exercises, can help manage PTSD symptoms and reduce reliance on substances. These techniques promote a sense of calm and control.

  5. Work with a Transformational Life Coach: A life coach specializing in recovery can provide personalized support and guidance. They can help uncover the underlying beliefs fueling addiction and trauma, offering strategies to build a purposeful and sober life. Coaching sessions can provide motivation, accountability, and a structured path to recovery.

  6. Create a Safety Plan: Developing a safety plan that includes coping strategies, emergency contacts, and steps to take during a crisis can help individuals manage PTSD and SUD symptoms effectively. A safety plan offers a concrete roadmap for dealing with intense moments of distress.

For me? A 12 Step program, transformational coaching and increased spiritual connection were the missing pieces of my sobriety puzzle. The 12 steps and transformational coaching helped me understand what my deep beliefs and thoughts were, how to work through them and how to move forward. I developed living skills and coping tools. Spirituality keeps me on a positive and purposeful path.

No one can do recovery on their own. We need a support system for identification, understanding, community, advice and a place that's safe for growth.


Recognizing the co-occurring signs of PTSD and SUD is a crucial step toward healing. With the right support and treatment, individuals can break free from the cycle of trauma and addiction. Transformational life coaching, combined with therapeutic interventions and support systems, can pave the way for a happier, more purposeful life. Remember, recovery is a journey, and it's important to seek help and take proactive steps towards wellness.

By addressing both PTSD and SUD with compassion and comprehensive care, there is hope and healing to those struggling with these intertwined challenges.

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